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Resolved Fiscal Intermediary Standard System Claims Processing Issues

Updated: 05.10.21

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved
03.08.2021 Closed Payment / Remittance Advice The penalties for late Requests for Anticipated Payments (RAPs) are correctly applying on the claim for the late RAP. However, the claim's penalty amount (shown with value code QF) is not being deducted from the final reimbursement of the claim, which is causing an out of balance on the remittance advice (RA). This out of balance is showing in the "Adjustment to Balance" field on the RA Summary page. NA Value Code QF 04.05.2021
Updates

04.05.2021 – This issue has been resolved. CGS will generate adjustments to correct reimbursement of the affected claims.

03.25.2021 – No additional update at this time.

03.08.2021 – The system maintainer and CMS are aware of this issue.

MAC Action

04.05.2021 – CGS will generate adjustments to correct reimbursement of the affected claims.

Provider Action

04.05.2021 – No provider action required.

02.09.2021 – No provider action is necessary at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved
02.09.2021 Closed Home Health Some Home Health PDGM claims that have dates of service that span 2020 - 2021 are not paying correctly. Instead of paying the 2021 Pricer rates, they are paying at the 2020 rates. NA Incorrect Reimbursement 04.05.2021
Updates

04.05.2021 – This issue has been resolved. CGS will generate adjustments to correct reimbursement of the affected claims.

03.25.2021 – A corrected home health Pricer program will be implemented on April 2, 2021, to correct this issue. Within 60 days after the corrected home health Pricer is installed, CGS will initiate adjustments to the affected claims.

03.08.2021 – An updated Pricer will be implemented on April 2, 2021.

MAC Action

04.05.2021 – CGS will generate adjustments to correct reimbursement of the affected claims.

03.25.2021 – Within 60 days after the corrected home health Pricer is installed, CGS will initiate adjustment to claims with a "From" date before January 1, 2021, a "Through" date on or after January 1, 2021, and a claims receipt date before April 2, 2021.

02.09.2021 – The system maintainer and CMS are aware of this issue.

Provider Action

04.05.2021 – No provider action is necessary.

03.25.2021 – No provider action is necessary.

02.09.2021 – No provider action is necessary at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved
01.20.2021 Closed Home Health Home Health requests for anticipated payments (RAPs) are going to the return to provider (RTP) file incorrectly with reason code W7216 indicating an invalid line item date. W7216 RAP type of bill 322 04.05.2021
Updates

04.05.2021 – This issue has been resolved.

03.25.2021 – A resolution to this issue is anticipated in the April 2021 system release.

03.08.2021 – No additional update at this time.

02.10.2021 – RAPs that are being suspended in status/location S MWRAP, are being reviewed by the Claims department. When applicable, this reason code will be overridden to allow the RAP to continue processing.

01.22.2021 – Until this issue is resolved the reason code W7216 has been revised to suspend RAPs in status/location S MWRAP.

MAC Action

01.20.2021 – CGS Technical Support staff is currently researching this issue.

Provider Action

04.05.2021 – No provider action required.

01.20.2021 – No provider action required at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved
09.27.2019 Closed Hospice CGS has identified two issues that affect some hospice claims with the type of bill (TOB) 8XC.

1. The Common Working File (CWF) has provided a work around when a provider is trying to transfer on 61st/91st day.
2. CWF is researching 8XC TOB when the previous provider's claim was billed with a Patient Status 50.
U514A TOB 8XC 03.31.2021
Updates

03.30.2021 – This issue has been resolved. No action is required for providers.

03.25.2021 – No additional update at this time.

03.08.2021 – No additional update at this time.

01.19.2021 – No additional update at this time.

11.30.2020 – No additional update at this time.

10.19.2020 – No additional update at this time.

09.25.2020 – No additional update at this time.

07.30.2020 – No additional update at this time.

07.10.2020 – No additional update at this time.

06.26.2020 – No additional update at this time.

06.12.2020 – No additional update at this time.

05.15.2020 – No additional update at this time.

04.06.2020 – No additional update at this time.

02.21.2020 – No additional update at this time.

01.14.2020 – No additional update at this time.

12.16.2019 – No additional update at this time.

11.12.2019 – No additional update at this time.

10.16.2019 – No additional update at this time.

10.04.2019 – The claims affected by these issues will be suspended in status/location S M514A for manual review.

MAC Action 10.04.2019 – The issues are being researched.
Provider Action 10.04.2019 – No provider action is necessary.
Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.28.2021

Closed

Home Health

The HH Pricer program is incorrectly applying a penalty to RAPs received more than 5 days earlier than the "FROM" date of the RAP. The associated claims cannot be readily identified for MAC suspension.

NA

Requests for Anticipated Payments (RAPs)

03.08.2021

Updates

03.08.2021 – The system fix has been implemented. CGS is in the process of completing the adjustments.

01.28.2021 – A system fix is scheduled for March 1, 2021. Once the fix is implemented, the Medicare Administrative Contractors (MACs) shall adjust claims with a value code QF amount greater than $0 (penalty amount) and a RAP RECEIPT DT of more than 5 days earlier than the "FROM" date.

MAC Action

 

Provider Action

03.08.2021 – No provider action necessary.

01.28.2021 – Agencies may still submit RAPs as they choose. We will provide updates when applicable.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

07.21.2020

Closed

Hospice

Payment for hospice routine home care (RHC) services are calculating incorrectly when there is a transfer involved.

NA

RHC (high/low payment)

03.08.2021

Updates

03.08.2021 – This issue has been resolved.

01.19.2021 – No additional update at this time.

11.30.2020 – No additional update at this time.

10.28.2020 – It has been determined that the anticipated January 2021 date to implement a resolution to this issue is no longer feasible. No additional date has been provided.

10.19.2020 – No additional update at this time.

09.25.2020 – No update at this time.

07.21.2020 – The Centers for Medicare & Medicaid Services (CMS) is aware of this issue. A resolution to resolve this issue is anticipated in January 2021.

MAC Action  
Provider Action

05.10.2021 – If a claim affected by this issue was processed or adjustment prior to April 19, 2021, you may need to adjust the claim again to receive the correct reimbursement.

04.22.2021 – If providers have claims that are affected by this issue, please submit an adjustment to receive the correct reimbursement.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.05.2021

Closed

Home Health

CR 11855 indicates starting 01/01/21 providers can submit both the first and 2nd RAP for a 60-day certification at the same time. Providers submit the RAP for the 2nd 30-day period with the first day of the period as the service date on the 0023 line. Because the claim's 0023 service date doesn't match the date of the first visit, the claim receives reason code U5391 indicating that it can't find a matching RAP.

U5391 or 38107

0023 Service Date

02.22.2021

Updates

02.22.2021 – When home health agencies use the new exception, which was implemented with MLN/CR 11855, and submit RAPs with the 1st day of the period of care as the service date on the 0023 line for subsequent periods of care in calendar year 2021, the corresponding claim must be submitted with the same date on the 0023 revenue code line. The service dates on the 0023 revenue code line on the RAP and the claim must match. Refer to the Reason Codes U5391 and 38107: No RAP or No Matching RAP is Found article for additional information.

02.12.2021 – This issue may also cause claims to receive reason code 38107.

MAC Action

02.09.2021 – This has been reported to the system maintainer.

Provider Action

02.09.2021 – No provider action is necessary at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.04.2021

Closed

Home Health

A zero total payment amount on LUPA claims, subject to the late 2021 RAP, penalty is causing out of balance problems on the remittance advice.

7ERTC

LUPA

02.25.2021

Updates  
MAC Action

02.25.2021 – The resolution to this issue has been implemented; therefore, claims suspended in status/location S MPRTC with reason code 7ERTC have been released to continue processing.

02.04.2021 – LUPA claims with a zero total payment, subject to the late 2021 RAP penalty, will be suspended in status/location S MPRTC with reason code 7ERTC. These will be held until the Pricer is corrected during implementation on 3/1/2021.

Provider Action

02.04.2021 – No provider action is necessary at this time.

Proposed Resolution

02.25.2021 – No claims were processed prior to the suspension; therefore, no adjustments are necessary.

02.04.2021 – After the fix is implemented, CGS will adjust any claims that processed prior to the suspension to correct the payment.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.07.2021

Closed

Home Health

Home health requests for anticipated payment (RAPs) with dates of service on or after January 1, 2021, are going to the Return to Provider (RTP) file incorrectly when value code 61 is not present. Per MM11855External PDF, value code (VC) 61 is optional.

32035

Value Code 61 on RAPs

01.13.2021

Updates

01.13.2021 – CGS received instruction from the Centers for Medicare & Medicaid Services (CMS) to implement a workaround. Claims receiving reason code 32035 will suspend (S status code), rather than RTP. Once suspended, CGS will add value code 61 and a placeholder CBSA code 10180 to the RAP so it can continue to process.

MAC Action

01.07.2021 – CGS and CMS are aware of this issue.

Provider Action

01.13.2021 – Due to the instructions received from CMS, there is no longer a need for providers to report VC 61 and the CBSA code. No further action is required for providers.

01.07.2021 – Although VC 61 is optional for RAPs with dates of service on or after January 1, 2021, providers should continue to report VC 61 until this issue can be resolved. If you have RAPs in the RTP file, apply the VC 61 and the CBSA code to resolve reason code 32035.

Proposed Resolution

01.13.2021 – See the "Updates" information above.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

11.20.2021

Closed

Hospice

Some hospice notices of election (NOEs) are posting to the Common Working File, but then going to the Return to Provider (RTP) file with reason code U5106.

U5106

NOE

02.08.2021

Updates

02.08.2021 – This issue is caused by an abnormal system termination at the Common Working File (CWF) that happens only occasionally. Refer to Provider Action below.

11.30.2020 – No additional update at this time.

MAC Action

11.10.2020 – CGS is researching the issue.

Provider Action

02.08.2021 – When an NOE is in the RTP file with reason code U5106, and the hospice election period is posted on CWF, contact the Home Health & Hospice Provider Contact Center for assistance.

11.10.2020 – No action for providers at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

11.10.2020

Closed

Hospice

Hospice claims submitted with Occurrence Span Code (OSC) 77 are incorrectly going to the Return to Provider (RTP) file with reason code 34923.

34923

OSC 77

01.19.2021

Updates

01.19.2021 – The reason code 34923 was modified to ensure hospice claims with OSC 77 only count the units in non-covered revenue code lines with a date of service within the OSC 77 dates.

11.30.2020 – No additional update at this time.

MAC Action
Provider Action

01.19.2021 – No action for providers.

11.10.2020 – No action for providers at this time

Proposed Resolution

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

04.17.2020

Closed

Hospice Health

When an 8XB NOTR is billed and the through date is past the current open benefit period on the Common Working File, the NOTR will open the next benefit period. This is working as expected. However, when the final hospice claim is submitted it is being sent to the Return To Provider (RTP) with reason code U5165.

U5165

8XB Type of Bill

04.27.2020

Updates

10.28.2020 –This issue has been resolved. Providers no longer need to follow the workaround identified in the Provider Action section below.

10.19.2020 – No additional update at this time.

09.25.2020 – No additional update at this time.

07.30.2020 – No additional update at this time.

07.10.2020 – No additional update at this time.

06.26.2020 – No additional update at this time.

06.12.2020 – No additional update at this time.

05.15.2020 – No additional update at this time.

05.05.2020 – No additional update at this time.

MAC Action

04.17.2020 – This issue is currently being researched by CWF.

Provider Action

10.28.2020 – This issue has been resolved. Providers no longer need to follow the workaround.

04.17.2020 – A workaround to this is to cancel the 8XB by billing an 8XD. Once this is completed, ensure the 42 occurrence code and discharge date are added to the final claim and F9 it out of RTP. If you haven't submitted the final claim yet, submit the 8X4 with the Occ Cd 42 and discharge date.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

07.10.2020

Closed

Home Health and Hospice

CGS has identified an issue causing some home health and hospice claims to receive reason codes 31138 and W7218 inappropriately.

31138 and W7218

NA

07.15.2020

Updates

07.15.2020 – Claims with reasons 31138 and W7218 in status/location S MOPPS have been released to continue processing.

07.10.2020 – Claims receiving these reason codes will be suspended in status/location S MOPPS.

MAC Action  
Provider Action

07.15.2020 – No action by providers is necessary.

07.10.2020 – No action required.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

07.09.2020

Closed

Home Health and Hospice

Reason Code 37578 is causing claims submitted via Direct Data Entry (DDE) to go to the Return to Provider (RTP) file incorrectly.

37578

Physician National Provider Identifier (NPI)

08.17.2020

Updates

09.25.2020 – This issue has been resolved.

07.30.2020 – A resolution to this issue is scheduled for implementation on August 17, 2020.

07.09.2020 – Claims are being sent to RTP incorrectly with reason code 37578. CGS is researching the issue.

MAC Action  
Provider Action

07.09.2020 – No action necessary at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

07.08.2020

Closed

Home Health

Home health claims submitted as part of the Maryland Total Cost of Care Model were denied incorrectly.

32072, 37236 and 37237

Type of Bill 032X

08.11.2020

Updates

07.13.2020 – Adjustments have been completed to previously denied home health claims submitted by nurse practitioners in Maryland as part of the Maryland Total Cost of Care Model.

07.08.2020 – CGS has been instructed by CMS to reprocess the previously denied home health claims submitted by nurse practitioners in Maryland as part of the Maryland Total Cost of Care Model.

MAC Action

07.08.2020 – CGS will reprocess claims with From dates of service on or after January 1, 2020, that were received before April 27, 2020. CMS has instructed CGS to complete this process by August 11, 2020. 

Provider Action

07.08.2020 – Providers may adjust the claims affected.

Proposed Resolution

07.08.2020 – Claims affected by this issue will be reprocessed by August 11, 2020.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

04.28.2020

Closed

Hospice

As a result of additional research, it has been determined that there is a continuing overpayment issue that occurs with hospice adjustments. The resolution implemented on January 20, 2020, did not correct this issue.

NA

Routine Home Care

06.12.2020

Updates

06.12.2020 – This issue has been resolved. Providers may adjust claims with routine home care days when the prior days used are greater than 60 as necessary.

05.15.2020 – No additional update at this time.

04.28.2020 – A resolution to this issue has now been scheduled for October 2020.

MAC Action  
Provider Action

06.12.2020 – Provider may continue to adjust claims as necessary.

04.28.2020 – Providers are advised to hold adjustments to claims with routine home care days when the prior days used are greater than 60.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

04.17.2020

Closed

All Home Health and Hospice Providers

CGS is aware of delays in answering questions that have been submitted to the CGS.ERS.CORR@cgsadmin.com mail box. Our resources have been focused on getting payments made and we are now working through the questions that have been submitted. It may take a few days to work through all the questions but you will get a response as quickly as possible.

NA

NA

06.01.2020

Updates  
MAC Action  
Provider Action  
Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

03.12.2020

Closed

Home Health

The HIPPS code on Home Health Patient-Driven Groupings Model (PDGM) claims are being recoded incorrectly.

NA

HIPPS Code

05.18.2020

Updates

06.12.2020 – CGS has initiated the adjustments for the two issues described below.

05.15.2020 – No additional update at this time.

04.27.2020 – There were two issues involved.

  1. The first affected 60-day episode claim that spanned January 1, 2020. If the number of therapy visits changed the HIPPS code, the HH Pricer program bypasses portions of the recoding process, causing appropriate recoding of the first and fourth positions of the HIPPS code but omitted the second and third positions. Claim my have been either over or under paid depending on whether therapy services increased or decreased during the period
  2. The second recoding issue affected 30-day period of care. When a claim reported an institutional referral source using codes 61 or 62, the Grouper coded the claim into an institutional payment group correctly and assigned early or late period timing correctly. However, if the Common Working File (CWF) records indicated that the early or late was incorrect, the claim received edits 524P (early period should be late) or 524Q (late period should be early). When the claim went through Grouper the second time to correct the period timing, the occurrence code 61 or 62 was omitted, resulting in incorrect assignment of community referral source causing the claim to be underpaid.

04.06.2020 – No additional update at this time.

03.12.2020 – This issue has been reported to the system maintainer and a fix to resolve this issue is anticipated in May 2020.

MAC Action

06.12.2020 – CGS has initiated the adjustments for the two issues described below.

04.27.2020

  1. For the first issue, the HH Pricer was corrected on the April 2020 release. CGS will adjust the affected home health claims within 60 days.
  2. For the second issue, FISS will correct this on May 4, 2020. CGS will adjust the affected home health claims within 60 days of the May 4th date.
Provider Action

06.12.2020 – No action is required by providers.

04.27.2020 – No action is required by providers.

Proposed Resolution 03.12.2020 – A fix to resolve this issue is anticipated in May 2020.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.14.2020

Closed

Hospice

For some hospice adjustments the end of life (EOL) Service Intensity Add-On (SIA) payment is not being made. This applies to some adjustments with dates of services prior to January 1, 2020, that were received on or after January 1, 2020.

NA

NA

04.20.2020

Updates

04.27.2020 – The fix to resolve this issue has been implemented.

04.06.2020 – A fix to resolve this issue has been scheduled for April 20, 2020.

MAC Action

02.14.2020 – None at this time.

Provider Action

04.06.2020 – Provider may resubmit adjustments that were affected by this issue.

02.14.2020 – Providers should keep track of their adjustments that apply to this issue.

Proposed Resolution

02.14.2020 – A fix for this issue will be implemented. No date has been scheduled at this time.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

03.25.2019

Closed

U5181

Updated Description: The U5181 edit issue is for monthly billing in which a hospice's provider liability (OSC 77) ends for a late Notice of Election (NOE). The hospice is accepting liability for the late NOE and is not requesting an exception. Edit U5181 edit is firing assuming it is for a late recertification, which it is not.

NA

Occurrence Code 27

04.06.2020

Updates

04.06.2020 – A fix to resolve was implemented with the April 6, 2020.

02.21.2020 – No additional update at this time.

01.14.2020 – No additional update at this time.

12.16.2019 – No additional update at this time.

11.22.2019 – Claims that receive reason code U5181 will be sent to the Return to Provider (RTP) file (status/location T B9997). Providers should continue to follow the instructions found in the "Provider Action" section below by adding Occurrence Code 27 and date that directly follows the through date reported with OSC 77. However, if you have verified that the claim should not have received U5181, contact the Provider Contact Center (PCC) at 1.877.299.4500. The PCC will notify the Claims department and the claim will be moved out of the RTP file to status/location S M5181 until a resolution is implemented.

11.06.2019 – If adding Occurrence Code 27 and date that directly follows the through date reported with OSC 77, as described in the "Provider Action" section below, does not work, the Claims department will suspend the claim in status/location S MU518. The claims will remain suspended until a resolution is implemented.

10.16.2019 – No additional update at this time.

09.26.2019 – No additional update at this time.

09.06.2019 – No additional update at this time.

08.16.2019 – No additional update at this time.

07.23.2019 – No additional update at this time.

06.26.2019 – See "Provider Action" below for a workaround to be used only when U5181 edits on a claim because the provider liability (Occurrence Span Code 77) ends (may have ended on last day of the previous month's claim) for a late Notice of Election (NOE).

06.18.2019 – No additional update at this time.

05.29.2019 – No additional update at this time.

05.15.2019 – No additional update at this time.

04.25.2019 – No additional update at this time.

04.09.2019 – No additional update at this time.

03.25.2019 – This issue has been reported and is currently in research. Updates will be provided when they become available.

MAC Action  
Provider Action

06.26.2019 – When U5181 edits on a claim because the provider liability (Occurrence Span Code 77) ends (may have ended on last day of the previous month's claim) for a late Notice of Election (NOE), hospices may add Occurrence Code 27 with the date that directly follows the through date reported with OSC 77. Hospices shall add "Remarks" to the claim (FISS Claim Page 04) stating the "CPIL Workaround: OC 27 added to bypass U5181 edit for a late NOE." Condition Code 85 should not be reported in this workaround, it is only reported when a recertification was untimely.

If the U5181 is received and OSC 77/date span is not on the claim or does not end on the last day of the previous month's claim, hospices are to verify their billing is correct with the steps described in the 05.15.2019 update (below) and return the claim for processing.

05.15.2019 – Please remember to verify if:

  • The OC 27 date is the correct date for the next period start date
  • The OC 27 date is within the DOS on the claim
  • OC 27 is only reported on the claim for the billing period in which the certification or recertification was obtained
  • The patient is in the first certification period when they transfer to another hospice, then the receiving hospice would use the same certification date as the previous hospice until the next certification period

The hospice received the recertification of terminal illness later than two days after the first day of a new benefit period, they must report condition code 85 on the claim. This code is reported with OSC 77, which reports the provider liable days associated with the untimely recertification. The OC 27 date should be the first day of covered charges (day after the thru date of OSC 77).

03.25.2019 – No provider action at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.24.2020

Closed

Home Health

Home health claims with dates of services on or after January 1, 2020, claims are going to the return to provider (RTP) file with reason code 37253 (no OASIS found). Currently, research does not indicate that there is a systems issue. Please refer to the Provider Action below.

37253

NA

 
Updates  
MAC Action  
Provider Action

02.24.2020 – The following 4 items must match between the claim and the OASIS submitted via iQIES. Refer to the Reason Code 37253 and the OASIS Assessment article for additional information.

  • Home health agency (HHA) Certification Number (OASIS item M0010)
  • Beneficiary Medicare Number (OASIS item M0063)

NOTE: The beneficiary's Medicare Beneficiary Identifier (MBI) may have changed; therefore, ensure the BMI matches between the claim and the OASIS.

  • Assessment Completion Date (OASIS item M0090)
  • Reason for Assessment (OASIS Item M0100) equal to 01, 03, or 04

It is important for providers to verify that the OASIS was successfully accepted into the iQIES database and that the above items match with the claim. If you believe the above items match between the OASIS and the claim, but you continue to encounter issues, please contact the PCC at 1.877.299.4500 (option 1) for further assistance. Please be prepared to provide screen prints of the OASIS acceptance report if requested.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

04.10.2020

Closed

Home Health

There is an issue with the iQIES files which is causing claims to go to the Return to Provider (RTP) file with 37253 (no OASIS assessment found.) This issue is occurring with all Medicare Administrative Contractors (MACs) who processes home health claims.

37253

NA

04.13.2020

Updates

04.13.2020 – This issue has been resolved.

04.10.2020 – This issue has been reported to Medicare and the system maintainer and is being researched.

MAC Action  
Provider Action

04.13.2020 – If you believe your claim went to RTP with reason code 37253 in error from April 6 through April 10, 2020, press F9 to move your claim out of RTP and continue processing

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.24.2020

Closed

Home Health and Hospice

CGS has identified an issue affecting (XX7 type of bill) and cancellations (XX8 Type of bill) that are submitted via Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE), which are returning with reason code 30918. When entering these adjustments and cancellations thru DDE, the incorrect Medicare Beneficiary Identifier (MBI) is being applied.

30918

 

0302.2020

Updates

03.02.2020 – The fix that resolved this issue was implemented over the weekend. The Claims department is working to release the adjustments and cancels that were suspended in status/location S MBII1 due to this issue.

MAC Action

03.02.2020 – The Claims department is working to release the adjustments and cancels that were suspended in status/location S MBII1 due to this issue.

02.24.2020 – These claims will be suspended to SMBII1. The Claims department will work to correct the MBI.

Provider Action

02.24.2020 – Some adjustments/cancels may have been sent to your Return to Provider (RTP) file (status/location T B9997). If you have adjustments in RTP with reason code 30918, please verify that it has the correct MBI and F9.

There are two options providers can choose from when entering adjustments/cancels. You may F9 each adjustment/cancel you enter, or after entering one adjustment/cancel, log out of FISS DDE and log back in to enter your next adjustment/cancel.

Proposed Resolution

02.24.2020 – A fix to this issue will be implemented and in production on Monday, March 2, 2020.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.10.2020

Closed

Hospice

Physician charges on hospice claims (revenue code 0657) received by CGS between 10.07.2019 – 01.05.2020 were overpaid.

NA

Revenue Code 0657 for claims received between 10.07.2019 – 01.05.2020

02.10.2020

Updates

02.21.2020 – This issue has been resolved. Refer to the MAC Action and Provider Action below.

MAC Action

02.10.2020 – CGS will adjust claims that are brought to their attention.

Provider Action

02.10.2020 – CGS will adjust claims that are brought to their attention.

Proposed Resolution

NA

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.21.2020

Closed

Home Health and Hospice

When a claim is entered via the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) with the Medicare Beneficiary Identifier (MBI), and when pressing F9 a reason code displays, the MBI changes to a Health insurance Claim Number (HICN). If the reason code is resolved, and the claim is stored, the claim is sent to the Return to Provider (RTP) file with reason code 30995 in error.

30995

MBI

02.12.2020

Updates

02.21.2020 – The system fix to resolve this issue was implemented on February 12, 2020.

02.07.2020 – The scheduled implementation date has been changed to February 12, 2020.

01.21.2020 – This issue has been reported and a resolution is scheduled for implementation on March 2, 2020.

MAC Action  
Provider Action

02.21.2020 – Providers should now be able to enter the MBI using FISS DDE.

01.20.2020 – This is only affecting claims entered into FISS via DDE. Claims can be submitted electronically.

Proposed Resolution 01.20.2020 – System release is scheduled for implementation on March 2, 2020.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

06.11.2019

Closed

Home Health and Hospice

If you have submitted an Appeal to CGS, the Interactive Voice Response (IVR) system is not acknowledging that it was received.

NA

Appeals

08.20.2020

Updates

08.20.2020 – It has been determined that this issue has been resolved.

07.30.2020 – No additional update at this time.

07.10.2020 – No additional update at this time.

06.26.220 – No additional update at this time.

06.12.2020 – No additional update at this time.

05.15.2020 – No additional update at this time.

04.06.2020 – No additional update at this time.

02.21.2020 – No additional update at this time.

01.14.2020 – No additional update at this time.

12.16.2019 – No additional update at this time.

11.12.2019 – No additional update at this time.

10.16.2019 – No additional update at this time.

09.26.2019 – No additional update at this time.

09.06.2019 – No additional update at this time.

08.16.2019 – No additional update at this time.

07.23.2019 – No additional update at this time.

06.26.2019 – No additional update at this time.

MAC Action

06.11.2019 – This issue has been reported for resolution.

Provider Action

06.11.2019 – Until appeals information is available in the IVR, you may access myCGS. If it has been over 65 days since your appeal was submitted, and you have not received a decision, please contact the Provider Contact Center at 1.877.299.4500.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

03.25.2019

Closed

Hospice

CGS has identified an ongoing issue with the two separate payment rates for hospice routine home care (RHC) services (high/low).

RHC high/low payment

01.20.2020

Updates

01.23.2020 – The resolution to this issue was implemented on January 20, 2020.

01.14.2020 – No additional update at this time.

12.16.2019 – As a result of additional research it has been determined that this issue occurs when an adjustment is made to an adjustment. A resolution to this issue has not yet been scheduled.

11.12.2019 – The Provider Contact Center (PCC) has reported that in some circumstances, the resolution that was implemented on October 21, 2019, was not successful. Additional research is being done and updates will be provided as they become available.

10.23.2019 – The fix to resolve this issue was not implemented until October 21, 2019.

10.16.2019 – The resolution to this issue was implemented on October 7, 2019. The Claims staff is currently reviewing claims to determine if this issue has been resolved.

09.26.2019 – No additional update at this time.

09.06.2019 – No additional update at this time. Refer to the Provider Action section below.

08.16.2019 – No additional update at this time. Refer to the Provider Action section below.

07.23.2019 – No additional update at this time.

06.18.2019 – No additional update at this time.

05.29.2019 – No additional update at this time. Refer to the Provider Action section below.

05.15.2019 – No additional update at this time. Refer to the Provider Action section below.

04.29.2019 – It has been verified that this issue involves transfer and non-transfer situations.

04.25.2019 – No additional update at this time. Refer to the Provider Action section below.

04.11.2019 – The April 11, 2019 issue of the MLN ConnectsExternal PDF includes the "Hold Hospice Adjustments to Avoid Underpayments" article indicating a fix will be implemented on October 7, 2019.

"On July 2, 2018, CMS changed Medicare's claims processing systems to better identify prior hospice days when calculating hospice routine home care payments after a transfer; see MLN Matters Article MM10180External PDF. This process is not working correctly, resulting in underpayment for these claims. CMS will fix this issue on October 7:

  • Until October 7, do not submit adjustments when there is a transfer within the benefit period
  • Beginning October 7 or after, resume submitting adjustments
  • If the dates of service are beyond the timely filling period, submit a reopening request using Type of Bill 8XQ"

04.09.2019 – No additional update at this time.

03.25.2019 – The system fix implemented on 3/4/2019 was not successful. This issue has been reported to the system maintainers.

MAC Action  
Provider Action

01.23.2020 – Providers may resume submitting adjustments. If the dates of service are beyond the timely filling period, submit a reopening request using Type of Bill 8XQ.

10.23.2019 – Providers may resume submitting adjustments. If the dates of service are beyond the timely filling period, submit a reopening request using Type of Bill 8XQ.

04.11.2019 – Until October 7, do not submit adjustments when there is a transfer within the benefit period.

You may resume submitting adjustments beginning October 7 or after.

If the dates of service are beyond the timely filling period, submit a reopening request using Type of Bill 8XQ

03.25.2019 – No provider action is required at this time.

Proposed Resolution 04.11.2019 – CMS

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

09.19.2019

Closed

Home Health and Hospice

The Centers for Medicare & Medicare Services (CMS) is aware of an issue causing the Medicare Beneficiary Identifier (MBI) on the incoming claim to link to an inactive Health Insurance Claim Number (HICN). This is impacting a limited number of claims.

38119, 30918, 30905, F5050, U5050, U5062

MBI

12.18.2019

Updates

12.18.2019 – After claims monitoring it appears that this issue has been resolved.

12.16.2019 – No additional update at this time.

11.12.2019 – No additional update at this time.

10.16.2019 – The Claims and Technical Support staff are reviewing the claims affected by this issue to ensure the resolution which was implemented on October 7, 2019, was successful.

09.26.2019 – No additional update at this time.

09.19.2019 – The claims affected by this issue are being suspended in status/location S MHMBI. A resolution to this issue has been scheduled for implementation on October 7, 2019. At that time, the claims will be released to continue processing.

MAC Action  
Provider Action

09.19.2019 – No action required.

Proposed Resolution

09.19.2019 – A resolution to this issue has been scheduled for implementation on October 7, 2019.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.31.2019

Closed

Home Health and Hospice

In some situations where providers are submitting claims under the Medicare Beneficiary Identifier (MBI), the claim processes under the beneficiary's Health Insurance Claim Number (HICN). This seems to occur when the Common Working File (CWF) shows that a new HICN is assigned to the beneficiary. New and subsequent claims are processing under the new HICN; when the prior claim information is under the old HICN and is not cross referencing to the new HICN. This is causing claims to go to the return to provider (RTP) file with reason code 38107 (matching home health RAP cannot be found) and 37402 (hospice sequential billing).

38107 and 37402

HICN and MBI

12.18.2019

Updates

12.18.2019 – After claims monitoring it appears that this issue has been resolved.

12.16.2019 – No additional update at this time.

11.12.2019 – No additional update at this time.

10.16.2019 – The Claims and Technical Support staff are reviewing the claims affected by this issue to ensure the resolution which was implemented on October 7, 2019 was successful.

09.26.2019 – Please refer to the Provider Action section below.

09.06.2019 – A resolution to this issue has been scheduled for implementation on October 7, 2019. Refer to the Provider Action below.

08.16.2019 – A resolution to this issue has been scheduled for implementation on October 7, 2019. Refer to the Provider Action below.

07.23.2019 – No additional update at this time.

06.18.2019 – No additional update at this time.

05.29.2019 – No additional update at this time.

05.15.2019 – No additional update at this time.

04.25.2019 – No additional update at this time.

04.09.2019 – No additional update at this time.

03.29.2019 – No additional update at this time.

03.15.2019 – No additional update at this time.

03.01.2019 – No additional update at this time.

02.14.2019 – No additional update at this time.

01.31.2019 – This issue has been reported to the system maintainers.

MAC Action

01.13.2019 – No action at this time.

Provider Action

09.26.2019 – No action at this time.

08.16.2019 – Providers are encouraged to submit claims with the MBI. Until the resolution to this issue is implemented, if this issue occurs, please contact the Provider Contact Center at 1.877.299.4500 (option 1) and they will work with the Claims staff to manually resolve the issue for your claim.

01.13.2019 – No action at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

11.06.2019

Closed

All Part A, Part B, home health and hospice providers

The Centers for Medicare & Medicaid Services (CMS) has identified an issue with obtaining current MSP information via the HIPAA Eligibility Transaction System (HETS). This affects MSP information available in myCGS, and the interactive voice response (IVR) system.

NA

MSP Eligibility

11.20.2019

Updates

11.20.2019 – The issue related to HETS returning incorrect MSP records is resolved.

11.11.2019 – The Common Working File (CWF) implemented system changes October 7, 2019. The CWF changes inadvertently resulted in sharing beneficiary MSP updates or new occurrences with HETS only when there is claims activity. The CWF MSP data is accurate; however, if a beneficiary's MSP information changed since October 7th and there hasn't been CWF claim activity for that beneficiary, HETS MSP data isn't current. CWF is the MSP information source for HETS, therefore, this affects the MSP information available via myCGS portal and IVR system. A resolution to this issue is scheduled for implementation the weekend of November 16th.

11.06.2019 – CGS will share updated information as it becomes available.

MAC Action

01.04.2019 – Updates will be provided as they become available.

Provider Action

01.04.2019 – Providers that have hospice adjustments in RTP with reason code U5150 or U5151 should contact the Provider Contact Center at 1.877.299.4500 (Option 1). CGS will then work with the Common Working File (CWF) to correct the hospice master record.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

05.14.2019

Closed

Hospice

Hospice providers may notice that the information provided in the Interactive Voice Response (IVR) system and myCGS may not reflect all current hospice periods. Please refer to Change Request 11277 for additional information.

NA

NA

10.16.2019

Updates

10.16.2019 – The resolution was implemented on October 7, 2019.

09.26.2019 – No additional update at this time.

09.06.2019 – No additional update at this time. A resolution will be implemented October 7, 2019, based on Change Request 11277.

08.16.2019 – No additional update at this time. A resolution will be implemented October 7, 2019, based on Change Request 11277.

07.23.2019 – No additional update at this time.

06.18.2019 – No additional update at this time.

05.29.2019 – No additional update at this time.

05.14.2019 – Change Request 11277 is to be implemented October 7, 2019.

MAC Action

12.04.2018 – CGS has reported this issue to the Common Working File (CWF).

Provider Action

05.14.2019 – No action at this time. Be sure to use the Common Working File (CWF) eligibility screens (ELGA or ELGH) to research hospice periods.

Proposed Resolution 05.14.2019 – Refer to the Change Request 11277External PDF which is scheduled for implementation October 7, 2019

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

10.09.2019

Closed

All Part A, Part B, home health and hospice providers

CGS has been notified by CWF that beneficiary eligibility dates may be missing from the CWF beneficiary files. They have received many examples and will be looking into the issue. This will affect eligibility inquiries using the myCGS portal, Interactive Voice Response (IVR) system and the CWF eligibility systems, ELGA/ELGH.

NA

Eligibility

10.15.2019

Updates

10.15.2019 – Due to processing issues at the Enrollment Database (EDB) entitlement data sent for new and/or updated beneficiaries processed at the Common Working File (CWF) between October 7, 2019 and October 9, 2019 posted with blank/ZERO entitlement dates causing some claims to reject with reason code U5200. After discovering the issue, CGS suspended some claims. The issue with the EDB has been corrected and the beneficiary entitlement dates have been restored. Please refer to the Provider Action and MAC Action section below for additional information.

10.09.2019 – Additional information will be provided when it becomes available.

MAC Action

10.15.2019 – Claims that were suspended with reason code U5200 will be released to continue processing.

10.09.2019 – No action at this time.

Provider Action

10.15.2019 – If you had claims reject with reason code U5200 as a result of this issue, please verify that the beneficiary was eligible on the date of service and the claim was rejected incorrectly, and resubmit the claim to CGS for processing.

10.09.2019 – No action at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

07.11.2019

Closed

Hospice

CGS is aware that Notices of Election (NOEs) are RTPing with reason code 32114 when the 9-digit ZIP code is not transmitted via EDI submission. NOEs submitted via DDE are currently processing correctly.

32114

RTP

08.19.2019

Updates

08.06.2019 – This issue has been resolved.

07.30.2019 – No additional update at this time. A resolution to this issue is scheduled for implementation on August 19, 2019. Refer to the Provider Action section below.

07.16.2019 – A resolution to this issue is scheduled for implementation on August 19, 2019. On August 20th, NOEs submitted via EDI submission should process without editing for the ZIP code.

MAC Action

07.30.2019 – A resolution to this issue is scheduled for implementation on August 19, 2019.

07.11.2019 – CGS is currently researching.

Provider Action

07.16.2019 – Providers may correct their NOEs that are in RTP with reason code 32114 by entering the full 9-digit ZIP code. CGS will also accept late NOE exceptions for this specific issue. When requesting an exception, enter Remarks stating "NOE was incorrectly returned due to the ZIP Code issue with reason code 32114."

07.11.2019 – Ensure that the full 9-digit ZIP code is transmitted. Please check this log for additional updates concerning EDI submission of NOEs.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

12.04.18

Closed

Hospice

Hospice claims are incorrectly rejecting with reason code C7080.

C7080

NA

05.14.2019

Updates

05.15.2019 – This issue has been resolved. Claims are no longer being rejected incorrectly.

04.25.2019 – No additional update at this time.

04.09.2019 – No additional update at this time.

03.25.2019 – No additional update at this time.

03.08.2019 – No additional update at this time.

02.21.2019 – No additional update at this time.

02.08.2019 – No additional update at this time.

01.18.2019 – No additional update at this time.

01.04.2019 – No additional update at this time.

12.04.2018 – Hospice claims are incorrectly rejecting with reason code C7080 indicating that one or more line item date of service overlaps with another claim.

MAC Action

12.04.2018 – CGS has reported this issue to the Common Working File (CWF).

Provider Action

05.14.2019 – No provider action is required.

12.04.2018 – No provider action is required at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

11.15.2018

Closed

Hospice

Hospice claims are receiving reason code U5175 incorrectly.

U5175

NA

05.14.2019

Updates

05.14.2019 – The CGS Claims department are now able to work the claims suspended with reason code U5175 to allow continued processing.

04.25.2019 – No additional update at this time.

04.09.2019 – No additional update at this time.

03.25.2019 – No additional update at this time.

03.08.2019 – No additional update at this time.

02.21.2019 – No additional update at this time.

02.08.2019 – No additional update at this time.

01.18.2019 – No additional update at this time.

01.04.2019 – No additional update at this time.

12.11.2018 – No additional update at this time.

11.15.2018 – Hospice claims receiving reason code U5175 incorrectly are being suspended in status/location S M90HP. U5175 suspends when a hospice transaction reverses a hospice revocation that will result in overlapping hospice election periods.

MAC Action

05.14.2019 – Claims suspended with reason code U5175 are being worked to continue processing.

11.15.2018 – Updates will be provided as they become available.

Provider Action

05.14.2019 – No provider action is required.

11.15.2018 – No provider action is required at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

04.17.2019

Closed

Home Health and Hospice

Claims submitted with a patient's Health Insurance Claim Number (HICN) rather than the Medicare Beneficiary Identifier (MBI) are not populating to the Standard Paper Remittance (SPR) although the information is showing on the 835 file.

NA

HICN

04.25.2019

Updates

04.25.2019 – The correction to this issue has been implemented.

04.17.2019 – The correction to the issue will be implemented into production on April 22, 2019.

MAC Action

04.17.2019 – The fix for this issue is scheduled to be implemented into production on April 22, 2019.

Provider Action

04.17.2019 – Providers may bypass this issue by submitting claims with the MBI. Only claims submitted with the HICN are not populating the patient's name on the SPR.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.10.2019

Closed

Home Health and Hospice

The Medicare Part B payment allowances for HCPCS code Q2038 and CPT code 90661 (flu vaccine) is not yet available.

37580 and 36602

HCPCS code Q2038 and CPT code 90661 (flu vaccine)

04.25.2019

Updates

04.25.2019 – Products described by these codes have not been available since 2016; therefore, the Centers for Medicare & Medicaid Services (CMS) do not have a payment amounts for these codes. Claims with these codes will be sent to the Return to Provider (RTP) file with reason code 79079 for providers to correct the claim with a valid code.

04.09.2019 – No additional update at this time.

03.25.2019 – No additional update at this time.

03.08.2019 – No additional update at this time.

02.21.2019 – No additional update at this time.

02.08.2019 – No additional update at this time.

01.14.2019 – The CPT code 90661 has been added to this issue.

01.10.2019 – Claims with dates of service on or after August 1, 2018, through July 31, 2019, submitted with HCPCS code Q2038 (flu vaccine) are being suspended in status/location S MFLU1. Refer to MM10914External PDF for additional information.

MAC Action

04.25.2019 – CGS will send claims to the RTP file with reason code 79079 in order for providers to correct.

01.10.2019 – Claims are being suspended in status/location S MFLU1 until the payment allowance is available.

Provider Action

04.25.2019 – Providers will need to correct claims in RTP with reason code 79079 by correcting the HCPCS code.

01.10.2019 – No action is necessary by providers.

Proposed Resolution

01.10.2019 – Once the payment allowance is available, claims will be released to continue processing.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

04.01.2019

Closed

Home Health and Hospice

The Common Working File (CWF) eligibility inquiry screens (ELGA/ELGH) are not allowing providers to access eligibility information.

NA

ELGA/ELGH

04.02.2019

Updates

04.02.2019 – This issue has been resolved. Providers may now access eligibility information via ELGA/ELGH.

MAC Action

04.01.2019 – CGS is currently researching the issue.

Provider Action

04.02.2019 – No provider action required.

04.01.2019 – Providers may obtain eligibility information by accessing myCGS or the Interactive Voice Response (IVR).

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.05.2019

Closed

Hospice

Some hospice adjustments continue to process with incorrect two tier (high/low) payment rates for Routine Home Care services.

 

Routine Home Care (RHC)

03.08.2019

Updates

03.08.2019 – The resolution scheduled for 3.4.2019 has been implemented. Providers may resubmit adjustment that previously paid incorrectly.

02.19.2019 – No additional update at this time.

02.05.2019 – This issue has been reported to the system maintainers. A resolution to this issue is scheduled for implementation on 3/4/2019.

MAC Action

03.08.2019 – No action.

Provider Action

03.08.2019 – Providers may resubmit adjustment that previously paid incorrectly.

02.05.2019 – No action is required at this time.

Proposed Resolution 02.05.2019 – A resolution will be implemented on 3/4/2019.

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

12.19.2018

Closed

Home Health

CGS has identified home health Requests for Anticipated Payments (RAPs) and final claims are being sent to the Return to Provider (RTP) file with reason code 1A005 (patient middle initial invalid). When some claims are selected to view in FISS Direct Data Entry, the claim screen is blank.

1A005 (patient middle initial is invalid)

NA

02.04.2019

Updates

02.08.2019 – The 02.04.2019 system release was implemented to resolve this issue. See "Provider Action" below.

01.18.2019 – The 01.17.2019 system release has been moved to 02.04.2019.

01.04.2019 – Two separate system releases have been scheduled for 01.07.2019 and 01.17.2019.

12.19.2018 – CGS is currently researching this issue. Updates will be provided as soon as they become available.

MAC Action

02.08.2019 – The 02.04.2019 system release was implemented.

Provider Action

02.08.2019 – The system releases should prevent future blank claims; however, the release does not resolve RAPs and final in RTP with reason code 1A005 or 1A006. Take the following actions to generate a beneficiary file to allow the blank RAPs or claims to finish processing.

  • Resubmit the RAP
  • Resubmit the final claim
  • Call the Provider Contact Center (PCC) at 1.877.299.4500 to add a beneficiary file.

12.19.2018 – No provider action is required at this time.

Proposed Resolution  

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Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

05.08.2018

Closed

Home Health and Hospice

Claims are being submitted with the new Medicare Beneficiary Identifier (MBI) and the Fiscal Intermediary Standard System (FISS) is attaching an invalid Health Insurance Claim Number (HICN) to the claim, causing the claim to go to the Return to Provider (RTP) file for various reasons.

Various reason codes (e.g., 38107 or 37402)

MBI

01.18.2019

Updates

01.18.2019 – This issue has been resolved. 

12.11.2018 – No additional update at this time.

11.13.2018 – No additional update at this time.

10.03.2018 – No update at this time. The CGS Claims staff continues to manually correct claims suspended in status/location S MPMBI.

08.30.2018 – No update at this time.

08.16.2018 – The claims suspended in status/location S MPMBI were corrected by the Claims Staff; however, it has been discovered that the update implemented on July 2, 2018, did not completely fix the issue. Some claims have continued to go to the RTP with reason codes 38107 and 37402. An edit will be set up to move those claims to the suspended status/location S MPMBI.

07.31.2018 – The CGS Claims staff continue to manually correct claims suspended in status/location S MPMBI.

07.12.2018 – It has been determined that the claims suspended in status/location S MPMBI will need to be manually corrected by CGS Claim staff. This issue will be updated once all suspended claims have been corrected.

07.06.2018 – The update was implemented on July 2, 2018; however, it appears the update did not resolve the issue. Additional research is being done.

05.17.2018 – The Centers for Medicare & Medicaid Services (CMS) has provided instructions to suspend home health and hospice claims submitted with an MBI that receive reason codes 38119, 38107, or 37402 until an update is installed. The update is currently scheduled for July 2, 2018. The affected claims will be suspended in status/location S MPMBI.

05.08.2018 – This issue has been reported to the FISS maintainer for additional research.

MAC Action

01.18.2019 – All claims that were suspended in S MPMBI with reason codes 38107 and 97402 have been released to continue processing.

08.16.2018 – An edit has been set up to suspend claims with reason codes 38107 and 37402 to status/location S MPMBI.

07.12.2018 – It has been determined that the claims suspended in status/location S MPMBI will need to be manually corrected by CGS Claim staff. This issue will be updated once all suspended claims have been corrected.

05.17.2018 – After the update, which is currently scheduled for July 2, 2018, is implemented, CGS will release the claims to continue processing.

05.08.2018 – None at this time.

Provider Action

01.18.2019 – No action is required.

08.16.2018 – If you have claims in the RTP file with reason codes 38107 and 37402, please F9 and they will move to the suspended status/location S MPMBI.

07.12.2018 – No action by providers required for claims suspended in status/location S MPMBI.

05.08.2018 – Providers may suppress the claim showing in the Return to Provider (RTP) file with the invalid HICN and resubmit the claim using the beneficiary's correct HICN.

Proposed Resolution  

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